Transmission of blood-borne infections (e.g. Hep B, Hep C, & HIV) from health care exposures was previously believed to be uncommon. However, multiple outbreaks across the United States over the last several years have shed light on this problem. In a recent article (Thompson N. D., et al., Nonhospital Health Care-Associated Hepatitis B and C Virus Transmission: United States, 1998-2008, Ann Intern Med 2009; 150(1):33-39, which is incorporated herein by specific reference in its entirety) reviewing outbreaks of nonhospital health care-associated Hep B & Hep C virus transmission in the United States from 1998-2008. 33 known outbreaks were identified. These events have resulted in 448 cases of Hep B and Hep C and >60,000 individuals exposed to potential blood-borne pathogens. As recently as October 2009, Broward General Medical Center (Florida) sent letters to >1800 patients who were potentially exposed to contaminated fluids. In this instance, the nurse routinely used the same bag of saline on multiple patients.
One such large outbreak occurred in an outpatient oncology clinic in Nebraska from 2000-2001. In this instance, the nurse would reuse a syringe to perform a saline flush. Saline for multiple patients was acquired from a common bag. More than 600 patients were notified. 99 patients were diagnosed with Hep C. These were all breaches of standard practice and should have never occurred. In many instances, veteran health care personnel were responsible for such poor practices. These cases all have in common acquisition of saline or a drug from a common container via a contaminated needle and/or syringe. Despite the increasing use of single-dose vials, such outbreaks occur as providers still use these single-dose vials on multiple individuals to contain costs.